58 yo female with DMII, HbA1C of 6.8, BP 138/80, on lisinopril 20mg, LDL of 70, not on a statin, presents for follow up. What do you do?
1. Increase lisinopril to 40mg
2. start a statin
3. do nothing
4. 1 and 2
A higher maximum systolic blood pressure target for diabetics is one of the most
significant changes in the American Diabetes Association's 2013 Standards of
Medical Care. The new goal is SBP less than 140 as opposed less then 130. The ACCORD Trial (Action to Control Cardiovascular Risk in Diabetes) assigned type 2 diabetics to intensive BP therapy (less then 120 systolic) and to less then 140 systolic. There were no significant differences in MI, stroke or death from cardiovascular causes or in annual all cause mortality. There were reductions in annual rates of total stroke thus certain patients do require a higher blood pressure goal if they are at high risk for stroke.
The new recommendations also contain changes regarding diabetes
self-management education, screening and treatment of cardiovascular risk
factors in prediabetes, and emphasizing statin therapy OVER specific low-density
lipoprotein cholesterol goals. A summary
of the revisions and an executive
summary of the standards are online.
http://care.diabetesjournals.org/content/36/Supplement_1/S3.full
